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BCS Abstracts 2011 Introduction Successful PCI for CTO may confer an improved prognosis and a reduction in major adverse cardiac events (MACE). However most trials have included occlusions of short duration (less than 4 weeks). In this study we assessed the impact of PCI on LV function in patients with true CTOs (TIMI flow grade 0 and greater than 12 weeks duration) using serial CMR imaging as well as the predictive value of late gadolinium enhancement when performed prior to revascularisation. Methods Thirty patients referred for PCI to a single vessel CTO underwent CMR examination prior to and 6 months after PCI. Technical success was defined as recanalisation of the occluded vessel and DES implantation with a final residual diameter stenosis
BCS Abstracts 2011 dysfunction. Over a follow-up period of 2.661.1 years there were 42 deaths. All-cause mortality was inversely related to baseline BCIS-1 JS (HR 2.20 (1.34 to 3.62), p¼0.002) and to post-PCI BCIS-1 JS (HR 3.98 (2.33 to 6.78), p¼0.0001). Increasing degrees of revascularisation were associated with improved survival (Abstract 33 figure 1); a revascularisation index of $ 0.67 was associated with a survival advantage compared to a RI #0.66 (HR 0.39 (0.24 to 0.54), p¼0.0001) (Abstract 33 table 2). A multiple regression model, incorporating age, acuity of presentation, LV function and renal failure, demonstrated that RI¼0.67e1 continued to be an independent predictor of survival (HR 0.51 95% CI 0.35 to 0.81, p¼0.004) (Abstract 33 figure 1). Abstract 32 Figure 1 33 COMPLETENESS OF REVASCULARISATION PREDICTS MORTALITY FOLLOWING PERCUTANEOUS CORONARY INTERVENTION: UTILITY OF THE BCIS-1 JEOPARDY SCORE doi:10.1136/heartjnl-2011-300198.33 K De Silva, G Morton, P Sicard, E Chong, A Indermeuhle, B Clapp, M Thomas, S Redwood, D Perera. St. Thomas’ Hospital, King’s College London, London, UK Introduction Many coronary-scoring systems are complicated to use on a day-to-day basis, have varying degrees of reproducibility and exclude important subsets of patients such as those with previous coronary artery bypass grafts (CABG) or left main stem (LMS) disease (Abstract 33 table 1). The recently described BCIS-1 Myocardial Jeopardy score (BCIS-1 JS), a modification of the Duke Jeopardy score to include LMS and CABG, is simple to use and overcomes many of these limitations. We assessed the prognostic relevance of the BCIS-1 JS in patients undergoing percutaneous coronary intervention (PCI). Abstract 33 Table 1 Left Main Stem Disease classified Duke Jeopardy Score (Original) Patients with CABG classified Ease of use Relevance to contemporary PCI x x O x O Syntax Score O x x O O BCIS-1 JS O O O O x Prognostic validation Methods Consecutive patients undergoing PCI between 2005 and 2009 a single cardiac centre were screened. Patients were eligible if they had undergone assessment of left ventricular function before PCI and the sample was enriched for coronary artery bypass graft (CABG) cases by using the following weightingd1 CABG: 3 non- CABG. Clinicians (who were blinded to clinical or outcome data) scored diagnostic and procedural coronary angiograms. The BCISd1 JS was recorded before and after PCI (range: 0 to 12) and a Revascularisation Index (RI) calculated as RI¼(JS PRE dJS POST )/JS PRE . RI¼1.0 indicates full revascularisation and 0 indicates no revascularisation. The primary end-point was all-cause mortality. Mortality data was captured by tracking the database of the UK Office of National statistics. Predictors of outcome were assessed by univariate and multivariate analyses. Results 660 patients were included (6869 years). 44% presented as acute coronary syndromes with 41% having left ventricular Cumulative survival according to Revascularisa- Abstract 33 Figure 1 tion Index (RI). Abstract 33 Table 2 Variables Univariate analysis HR (95% CI) p value Multivariate analysis HR (95% CI) p value Revascularisation 0.36 (0.24 to 0.54) 0.0001 0.51 (0.33 to 0.81) 0.004 Index (0.67e1) BCIS-1 JS pre PCI 1.26 (1.14 to 1.39) 0.0001 1.14 (0.65 to 2.02) 0.65 BCIS-1 JS post PCI 1.35 (1.23 to 1.48) 0.0001 1.78 (0.93 to 3.39) 0.08 LV impairment 3.76 (2.53 to 5.58) 0.0001 1.97 (1.21 to 3.20) 0.007 Age 1.04 (1.01 to 1.08) 0.01 1.04 (1.00 to 1.08) 0.05 Renal dysfunction 5.82 (2.77 to 12.24) 0.0001 3.74 (1.60 to 7.37) 0.002 Acute coronary 2.31 (1.24 to 4.30) 0.008 1.30 (0.63 to 2.66) 0.47 syndrome Cardiogenic shock 14.56 (6.45 to 32.88) 0.0001 2.83 (0.69 to 11.54) 0.15 Previous CABG 3.35 (1.80 to 6.25) 0.0001 1.83 (0.88 to 3.82) 0.10 Conclusion The BCIS-1 Jeopardy Score predicts mortality following PCI. Furthermore, it can be used to assess the degree of revascularisation, with more complete revascularisation (RI$0.67) conferring a survival advantage in the medium term. 34 COMPARISON OF PCI VS CABG IN INSULIN TREATED AND NON-INSULIN TREATED DIABETIC PATIENTS IN THE CARDIA TRIAL doi:10.1136/heartjnl-2011-300198.34 1 A Baumbach, 2 S Kesavan, 3 K Beatt, 4 E Cruddas, 4 M Flather, 2 G Angelini, 5 R Hall, 6 A Kapur. 1 Bristol Heart Institute, Bristol, UK; 2 Bristol Heart Institute, Bristol, UK; A24 Heart June 2011 Vol 97 Suppl 1
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